1. 2016;19;E671-E674Late Extrusion of an Implantable Pulse Generator of a Spinal Cord Stimulator
   Brief Commentary
   Joseph Rabi, MD, and Magdalena Anitescu, MD, PhD.

The objective of this manuscript was to report a case of a patient with extruded pulse generator 3 years after implantation of a spinal cord stimulator system.

With the increasing incidence of chronic pain, spinal cord stimulation (SCS) is becoming more commonly utilized by pain physicians. SCS is a generally safe intervention with minimal adverse effects; however, there are risks of complications which practitioners should be aware of prior to and after placement of the SCS.

We present a case of a patient with a late complication of extrusion of an implantable pulse generator (IPG) of a SCS that was promptly identified and successfully removed without any complications. A 60-year-old male truck driver with history of failed back syndrome and diabetes underwent a SCS system implanted with excellent relief of his pain. The SCS was implanted with 2 leads with the IPG being sutured 3 cm in depth in the superior gluteal region. Three years after the implantation, he developed pain over the site of the generator and presented to our clinic with extrusion of the non-rechargeable pulse generator from his gluteal region.

The pulse generator was successfully removed with the battery not being infected. This late complication may have been related to his ongoing profession of daily driving with pressure necrosis from prolonged sitting and constant vibration during long rides associated. Structural size and design of the pulse generator may have had an important contribution as well. To our knowledge this complication has not been reported in the literature.

Physicians that place or manage patients with SCSs should be aware of this rare complication and maintain vigilance even after remote implantation of the SCS systems.

Key words: Spinal cord stimulator, complication, extrusion, implantable pulse generator, neuromodulation, failed back syndrome, battery complication